Heart transplant

Who needs a heart transplant?

The first successful UK heart transplant was performed in 1979. Now, up to 200 heart transplants are carried out in the UK each year.Heart transplant surgery might be considered if you have a condition that’s causing severe heart failure. This means your heart isn't pumping as much blood and oxygen around your body as it should.

If your condition isn’t improving and other treatments aren't helping, your cardiologist might send you for a transplant assessment. A transplant assessment might include blood tests, antibody tests and tests of your heart, lungs and blood vessels.

Ask your doctor about these tests before you go for your assessment to get prepared. Based on the transplant assessment, you might be:

• suitable for a transplant, in which case you will be put onto the active transplant waiting list. This means you might be called for a transplant at any time
• potentially suitable for a transplant, but your current condition isn't severe enough to put you on the waiting list. If this happens your case will be looked at regularly. If your condition gets worse, you'll then go on the waiting list
• in need of further investigations or treatment. This means more information is needed before a decision is made
• not suitable for a heart transplant. This may happen because you’re too ill, recovering from a recent serious illness, or can’t take the medicines after surgery. If so, you can discuss other treatments with your transplant team.

What are the benefits and risks of a heart transplant?

A heart transplant is the best option if you have a condition that’s causing heart failure. Benefits of the surgery can include:

• living a longer life
• a better quality of life
• more energy.

Around three quarters of UK heart transplant patients live for at least 5 years. However, there can be complications (problems) before, during and after surgery. The most common complications include:

• when your body tries to reject the donor heart because it knows it’s a different heart
• infections – serious infections are rare, but chest and urine are the most common. You’ll may be treated with antibiotics if this happens
• problems with your kidneys
• high blood pressure
• diabetes
• a higher risk of some forms of cancer.

While most of the complications are manageable, your transplant team will monitor you closely during this time. That’s why it’s essential you attend appointments during your recovery.

How long is the wait for a heart transplant?

The time it takes to be offered a transplant depends on several factors personal to you. First, your doctor will assess you and place you on one of three waiting lists:

routine – if you’re relatively healthy

urgent – if you’re unwell

super-urgent – if you’re critically ill

Although you’ll usually receive a transplant quicker if you’re on a more urgent list, this doesn’t always happen. You can move up a list if you become more ill.

Whether you’re offered a donor heart can depend on:

• which waiting list you’re on
• how long you’ve been waiting
• how much the heart will benefit you
• if your blood type matches a donor heart
• if your height and weight is like a donor’s (to match the size of the donor heart)
• if you have antibodies that may react with a donor heart (antibodies sometimes reject donor hearts).

Donor hearts can come from anywhere in the UK or sometimes other countries in Western Europe. The transplant team will try to guess how long you might wait. A suitable heart could be available within days or it might take months or even years.

Unfortunately, around one in six people don’t receive the heart transplant they need. While there’s nothing you can do about the wait, you can give yourself the best chance at being ready for the surgery and recovery by preparing yourself.

Preparing yourself includes managing the worry or difficult feelings of waiting in a good way, reducing stress, doing things you enjoy and staying fit. Find out how to get in shape for surgery with our five tips.

Some patients being considered for a heart transplant may need to have a left ventricular assist device (LVAD), if their cardiologist thinks they need it to survive until a suitable donor heart becomes available. This device helps pump blood around the body.

Do I have to accept a donor organ offer?

When a donor heart is available, your transplant team will check if it could match you. Accepting or rejecting an offer is up to you and your transplant team who will advise you on what they think is best. If you don’t accept an offer, the donor organ will be offered to someone else and you’ll be placed back on the list to wait for another match.

Not every donor organ has to be accepted by you and the transplant team. This can be for reasons, like:

• if the organ isn’t from the right type of donor (donor organs come with different risks like how long they’ll last – this is a discussion you’ll have when you join a waiting list)
• if the organ is at a higher risk of failing
• if you’ve suffered a recent infection
• if you’re too ill for surgery.

What happens in a heart transplant operation?

A heart transplant operation usually takes between four and six hours. Your surgeon will think about the best way to do the transplant for you. The steps they’ll usually follow are:

• at the start of the procedure, you’ll be given a general anaesthetic (a medicine to put you to sleep)
• the surgeon will make a cut in your breastbone (the middle of the chest) to get to your heart
• you'll be connected to a heart-lung bypass machine. This keeps your heart and lung going during the operation, pumping blood around your body
• your surgeon will then work on the transplant
• when this is finished, they'll start your heart beating again
• when your heart begins to take over pumping and your condition is steady, the heart-lung machine will be turned off
• the surgeon will then close your breastbone by stitching it with wire, which will stay there for the rest of your life.

After the operation you'll be moved to the intensive care unit. Most people wake up the day after, but it can take a little longer as the anaesthetic wears off.

You'll be given medicine and a ventilator machine which helps you breathe until you can do it yourself. From there, you’ll be moved into a high dependency unit or a ‘step down’ ward which is for people who need a higher level of care than normal.

How do I recover after a heart transplant?

Most people leave hospital within about four weeks of the operation, but this can take longer. A member of the transplant team will prepare you for going home and talk about your aftercare.

To make sure your heart transplant is as successful as possible, you may need to make changes to your lifestyle. Here are some things you can do to help your recovery:

• attend all your appointments – it’s important to go even if you feel well so doctors can check how you’re doing and change medications if needed
• keep your surgery wound clean and dry
• take your medication exactly as prescribed. Contact your transplant team if you have problems with your medications or if you are not sure how or when to take them
• wear sunblock when you go outside and spend less time in the sun during hot parts of the year. After a transplant you’re at a higher risk of developing skin cancer
• don’t smoke – this is a fresh start to keep your heart healthy
• do regular exercise - such as walking around your home and building up to short walks outside
• eat a healthy, balanced diet – start by getting 1-2 portions of fruit and veg with every meal and avoid too much sugar, saturated fats and salt
• aim to control your cholesterol and blood pressure levels - swap saturated fats (butter, processed meats, biscuits) for unsaturated fats (olive oil, oily fish, nuts), maintaining a healthy weight, and reduce salt in your diet.

Another important way to recover is to be aware of personal and food hygiene to avoid getting an infection. You can do this by:

1. avoiding anyone who has an infection, including cold, flu and Covid
2. not eating high-risk foods that could cause food poisoning such as raw eggs, mayonnaise, raw meats, unpasteurised milk and cheeses, and shellfish
3. keeping your pets healthy, wormed, and vaccinated so you don’t pick up any parasites or germs that can cause illness. You should also avoid changing cat litter trays (the infection toxoplasmosis is carried by cats)
4. washing your hands after gardening or if you have been handling any pets to avoid picking up parasites and germs.

It’s a good idea to get onto a cardiac rehab programme. Cardiac rehab can help you to recover as quickly as possible and talk about your experience with others who've been through similar. The programme includes supervised exercise and advice on how to lead a healthy lifestyle. We also have an at home programme available so check with your team if this is suitable for you.

How will I feel after a heart transplant?

Many people say their time in hospital becomes a blur afterwards. You may find it helpful to write down or have someone with you to help remember the information you get throughout your journey.

It’s okay to feel low after surgery, like many people do. The transplant team can help you if you want to talk with them. Don't forget to talk to family or friends about how you feel. We know this can be a difficult thing to do, so we’ve made a page with tips on talking about your heart and circulatory condition.

Your emotional recovery is important too. Visit our emotional wellbeing hub to find out more about ways of coping, and read similar stories from other people.

What will my life be like after a heart transplant?

Once you’ve recovered from surgery you should be able to return to activities including driving, holidays, sports and work. Your recovery depends on you, so talk with your doctor about when you might be able to do some of these activities.

You'll need to take several medicines, including immunosuppressants (also known as anti-rejection medicines), for the rest of your life. Without them your body would think your new heart was ‘foreign’ and try to reject it. This type of medicine can have side-effects, and there may also be medications that you can't take with it. Speak to your doctor about your medication.

After the operation, you'll have a wound along your breastbone that will heal over time. It’s normal to be worried or scared about having scars after surgery. Listen to others who tell us how they learned to accept their scars.

If you’re thinking of starting a family after a heart transplant, it’s very important that you talk with your transplant team before you try. This is so they can personally advise you on the risks, planning and medications involved. You can also speak to them about similar topics like contraception and hormone replacement therapy (HRT).

Where can I find out more?

The NHS Blood and Transplant is a special health authority that provides a blood and transplantation service to the NHS. This includes managing the donation, storage and transplantation of organs, alongside making sure that donated organs are matched and used in a fair way. 

Are you up to date on organ donation?

Did you know that in the UK three people a day die in need of an organ?

There’s now an opt-out system in place in the UK, meaning you automatically agree to be a donor when you die. You can opt out of this system if you like, but as of November 2022, there were nearly 7000 people on the UK transplant waiting list.

It’s up to your family to honour your wishes when you die, so talk to them and let them know how you feel.

Find more information about organ donation.

More information and support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have.
• Sign up to our Heart Matters magazine for online information packed with health and lifestyle advice.
• join a heart transplant support group to talk with others who've had a transplant or are on the waiting list for one.